VARIATIONS IN THE PERFORMANCE OF HIP FRACTURE PROCEDURES

OBJECTIVES. Hip replacement is the preferred treatment for displaced f emoral neck fractures, whereas other less expensive procedures are pre ferred for nondisplaced fractures. The authors determined whether ther e was geographic variation in the use of hip replacement to treat disp laced and nondisplaced fractures. METHODS. The authors studied 332 pat ients, age 65 years or older, hospitalized with a femoral neck fractur e in three cities. RESULTS. The population was 55% over age 80, 80% fe male, and lived in Houston (17%), Pittsburgh (29%), and Minneapolis (5 4%). Rates of hip replacement varied by city (Houston-84%, Pittsburgh- 77%, Minneapolis-63%; P = 0.002), with great variability among patient s with nondisplaced fractures (Houston-88%, Pittsburgh-77%, and Minnea polis-56%; P = 0.0001), and no variation among those with displaced fr actures (P = 0.72). Other factors associated with hip replacement are history of hip fracture (P = 0.003) and cerebrovascular disease (P les s than or equal to 0.10), APACHE II-APS score (P = 0.09), and impacted fracture (P = 0.001). Sociodemographic and functional status (perceiv ed health; activities of daily living and instrumental activities of d aily living dependencies) were not associated with hip replacement (P > 0.10). In a logistic model controlling for prior history, APACHE II- APS, and fracture characteristics, city remained a significant predict or of hip replacement (P < 0.001). CONCLUSIONS. Despite an absence of evidence supporting its appropriateness and a much higher cost, hip re placement is used to treat nondisplaced fractures much more frequently in Houston and Pittsburgh than in Minneapolis.